nach oben

Erschienen in:

01.04.2011 | Original Article

The effect of one-lung ventilation upon pulmonary inflammatory responses during lung resection

verfasst von: Yusuke Sugasawa, Keisuke Yamaguchi, Seiichiro Kumakura, Taisuke Murakami, Toyoki Kugimiya, Kenji Suzuki, Isao Nagaoka, Eiichi Inada

Erschienen in: Journal of Anesthesia | Ausgabe 2/2011

Einloggen, um Zugang zu erhalten

Abstract

Purpose

One-lung ventilation (OLV) is commonly used during thoracic surgery. Clinical studies using bronchoalveolar lavage fluid analysis have demonstrated that OLV induces pulmonary inflammatory reactions in the ventilated dependent lung. However, few clinical studies have investigated such inflammatory reactions in the dependent lung compared with the collapsed nondependent lung. Here we used a bronchoscopic microsampling method to obtain epithelial lining fluid (ELF) from each lung, and then compared the inflammatory reactions in the dependent lung and the nondependent lung during thoracic surgery.

Methods

Twenty adult patients were studied. All patients underwent thoracic surgery using OLV. Propofol and remifentanil were used for total intravenous anesthesia. A double-lumen endotracheal tube was used to perform OLV. ELF was obtained from each lung using the bronchoscopic microsampling method. ELF levels of inflammatory mediators, tumor necrosis factor α, interleukin (IL)-1β, IL-6, IL-8, IL-10, and IL-12p70 were measured using ELISA before and after OLV.

Results

ELF levels of IL-1β, IL-6, and IL-8 were significantly increased in the dependent lung and the nondependent lung at the end of surgery compared with their baseline levels (p < 0.05). ELF level of IL-6 was significantly higher in the dependent lung than in the nondependent lung at the end of surgery (p = 0.019).

Conclusions

One-lung ventilation induced inflammatory responses of the bronchial epithelia in the dependent lung and the nondependent lung during thoracic surgery. In addition, these inflammatory responses were more augmented in the dependent lung than in the nondependent lung.

Schilling T, Kozian A, Huth C, Bühling F, Kretzschmar M, Welte T, Hachenberg T. The pulmonary immune effects of mechanical ventilation in patients undergoing thoracic surgery. Anesth Analg. 2005;101:957–65.PubMedCrossRef

De Conno E, Steurer M, Wittlinger M, Zalunardo M, Weder W, Schneiter D, Schimmer R, Klaghofer R, Neff T, Schmid E, Spahn D, Z’graggen B, Urner M, Beck-Schimmer B. Anesthetic-induced improvement of the inflammatory response to one-lung ventilation. Anesthesiology. 2009;110:1316–26.PubMedCrossRef

Baudouin S. Lung injury after thoracotomy. Br J Anaesth. 2003;91:132–42.PubMedCrossRef

Fernández-Pérez E, Keegan M, Brown D, Hubmayr R, Gajic O. Intraoperative tidal volume as a risk factor for respiratory failure after pneumonectomy. Anesthesiology. 2006;105:14–8.PubMedCrossRef

von Bethmann A, Brasch F, Nüsing R, Vogt K, Volk H, Müller K, Wendel A, Uhlig S. Hyperventilation induces release of cytokines from perfused mouse lung. Am J Respir Crit Care Med. 1998;157:263–72.

Madjdpour C, Oertli B, Ziegler U, Bonvini J, Pasch T, Beck-Schimmer B. Lipopolysaccharide induces functional ICAM-1 expression in rat alveolar epithelial cells in vitro. Am J Physiol Lung Cell Mol Physiol. 2000;278:L572–9.PubMed

Voigtsberger S, Lachmann R, Leutert A, Schläpfer M, Booy C, Reyes L, Urner M, Schild J, Schimmer R, Beck-Schimmer B. Sevoflurane ameliorates gas exchange and attenuates lung damage in experimental lipopolysaccharide-induced lung injury. Anesthesiology. 2009;111:1238–48.PubMedCrossRef

Bless NM, Huber-Lang M, Guo RF, Warner RL, Schmal H, Czermak BJ, Shanley TP, Crouch LD, Lentsch AB, Sarma V, Mulligan MS, Friedl HP, Ward PA. Role of CC chemokines (macrophage inflammatory protein-1 beta, monocyte chemoattractant protein-1, RANTES) in acute lung injury in rats. J Immunol. 2000;164:2650–9.PubMed

Vozzelli MA, Mason SN, Whorton MH, Auten RL. Antimacrophage chemokine treatment prevents neutrophil and macrophage influx in hyperoxia-exposed newborn rat lung. Am J Physiol Lung Cell Mol Physiol. 2004;286:L488–93.PubMedCrossRef

10.

Beck-Schimmer B, Schwendener R, Pasch T, Reyes L, Booy C, Schimmer RC. Alveolar macrophages regulate neutrophil recruitment in endotoxin-induced lung injury. Respir Res. 2005;6:61.PubMedCrossRef

11.

Michelet P, D’Journo X, Roch A, Doddoli C, Marin V, Papazian L, Decamps I, Bregeon F, Thomas P, Auffray J. Protective ventilation influences systemic inflammation after esophagectomy: a randomized controlled study. Anesthesiology. 2006;105:911–9.PubMedCrossRef

12.

D’Journo X, Michelet P, Marin V, Diesnis I, Blayac D, Doddoli C, Bongrand P, Thomas P. An early inflammatory response to oesophagectomy predicts the occurrence of pulmonary complications. Eur J Cardiothorac Surg. 2010;37:1144–51.PubMedCrossRef

13.

Schilling T, Kozian A, Kretzschmar M, Huth C, Welte T, Bühling F, Hedenstierna G, Hachenberg T. Effects of propofol and desflurane anaesthesia on the alveolar inflammatory response to one-lung ventilation. Br J Anaesth. 2007;99:368–75.PubMedCrossRef

14.

Ishizaka A, Watanabe M, Yamashita T, Ogawa Y, Koh H, Hasegawa N, Nakamura H, Asano K, Yamaguchi K, Kotani M, Kotani T, Morisaki H, Takeda J, Kobayashi K, Ogawa S. New bronchoscopic microsample probe to measure the biochemical constituents in epithelial lining fluid of patients with acute respiratory distress syndrome. Crit Care Med. 2001;29:896–8.PubMedCrossRef

15.

Koh H, Tasaka S, Hasegawa N, Asano K, Kotani T, Morisaki H, Takeda J, Fujishima S, Matsuda T, Hashimoto S, Ishizaka A. Vascular endothelial growth factor in epithelial lining fluid of patients with acute respiratory distress syndrome. Respirology. 2008;13:281–4.PubMedCrossRef

16.

Wilson WC, Benumof JL. Respiratory physiology and respiratory function during anesthesia. In: Miller RD, editor. Miller’s anesthesia. 6th ed. Philadelphia: Elsevier/Churchill Livingstone; 2005. p. 679–722.

17.

Misthos P, Katsaragakis S, Theodorou D, Milingos N, Skottis I. The degree of oxidative stress is associated with major adverse effects after lung resection: a prospective study. Eur J Cardiothorac Surg. 2006;29:591–5.PubMedCrossRef

18.

Tekinbas C, Ulusoy H, Yulug E, Erol M, Alver A, Yenilmez E, Geze S, Topbas M. One-lung ventilation: for how long? J Thorac Cardiovasc Surg. 2007;134:405–10.PubMedCrossRef

19.

Galvin I, Drummond G, Nirmalan M. Distribution of blood flow and ventilation in the lung: gravity is not the only factor. Br J Anaesth. 2007;98:420–8.PubMedCrossRef

20.

Chang H, Lai-Fook S, Domino K, Schimmel C, Hildebrandt J, Robertson H, Glenny R, Hlastala M. Spatial distribution of ventilation and perfusion in anesthetized dogs in lateral postures. J Appl Physiol. 2002;92:745–62.PubMed

21.

Halliwell B. Reactive oxygen species in living systems: source, biochemistry, and role in human disease. Am J Med. 1991;91:14S–22S.PubMedCrossRef

22.

Winter P, Smith G. The toxicity of oxygen. Anesthesiology. 1972;37:210–41.PubMedCrossRef

23.

Clark J, Lambertsen C. Pulmonary oxygen toxicity: a review. Pharmacol Rev. 1971;23:37–133.PubMed

24.

Clark J. Pulmonary limits of oxygen tolerance in man. Exp Lung Res. 1988;14(Suppl):897–910.PubMedCrossRef

25.

Lohser J. Evidence-based management of one-lung ventilation. Anesthesiol Clin. 2008;26:241–72.PubMedCrossRef

26.

Kolobow T, Moretti M, Fumagalli R, Mascheroni D, Prato P, Chen V, Joris M. Severe impairment in lung function induced by high peak airway pressure during mechanical ventilation. An experimental study. Am Rev Respir Dis. 1987;135:312–5.PubMed

27.

Whitehead T, Slutsky A. The pulmonary physician in critical care. 7: Ventilator induced lung injury. Thorax. 2002;57:635–42.

28.

Kozian A, Schilling T, Fredén F, Maripuu E, Röcken C, Strang C, Hachenberg T, Hedenstierna G. One-lung ventilation induces hyperperfusion and alveolar damage in the ventilated lung: an experimental study. Br J Anaesth. 2008;100:549–59.PubMedCrossRef

29.

Kozian A, Schilling T, Schütze H, Heres F, Hachenberg T, Hedenstierna G. Lung computed tomography density distribution in a porcine model of one-lung ventilation. Br J Anaesth. 2009;102:551–60.PubMedCrossRef

30.

Wolthuis E, Choi G, Dessing M, Bresser P, Lutter R, Dzoljic M, van der Poll T, Vroom M, Hollmann M, Schultz M. Mechanical ventilation with lower tidal volumes and positive end-expiratory pressure prevents pulmonary inflammation in patients without preexisting lung injury. Anesthesiology. 2008;108:46–54.PubMedCrossRef

31.

Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network. N Engl J Med. 2000;342:1301–8.

32.

Slutsky A. Mechanical ventilation. American College of Chest Physicians’ Consensus Conference. Chest. 1993;104:1833–59.PubMedCrossRef

33.

Funakoshi T, Ishibe Y, Okazaki N, Miura K, Liu R, Nagai S, Minami Y. Effect of re-expansion after short-period lung collapse on pulmonary capillary permeability and pro-inflammatory cytokine gene expression in isolated rabbit lungs. Br J Anaesth. 2004;92:558–63.PubMedCrossRef

34.

Hamvas A, Palazzo R, Kaiser L, Cooper J, Shuman T, Velazquez M, Freeman B, Schuster D. Inflammation and oxygen free radical formation during pulmonary ischemia–reperfusion injury. J Appl Physiol. 1992;72:621–8.PubMed

35.

De Leyn P, Lerut T, Schreinemakers H, Van Raemdonck D, Mubagwa K, Flameng W. Effect of inflation on adenosine triphosphate catabolism and lactate production during normothermic lung ischemia. Ann Thorac Surg. 1993;55:1073–8.PubMedCrossRef

36.

Hamvas A, Park C, Palazzo R, Liptay M, Cooper J, Schuster D. Modifying pulmonary ischemia–reperfusion injury by altering ventilatory strategies during ischemia. J Appl Physiol. 1992;73:2112–9.PubMed

37.

Madjdpour C, Jewell U, Kneller S, Ziegler U, Schwendener R, Booy C, Kläusli L, Pasch T, Schimmer R, Beck-Schimmer B. Decreased alveolar oxygen induces lung inflammation. Am J Physiol Lung Cell Mol Physiol. 2003;284:L360–7.PubMed

38.

Padley S, Jordan S, Goldstraw P, Wells A, Hansell D. Asymmetric ARDS following pulmonary resection: CT findings initial observations. Radiology. 2002;223:468–73.PubMedCrossRef

Titel: The effect of one-lung ventilation upon pulmonary inflammatory responses during lung resection
verfasst von: Yusuke Sugasawa
Keisuke Yamaguchi
Seiichiro Kumakura
Taisuke Murakami
Toyoki Kugimiya
Kenji Suzuki
Isao Nagaoka
Eiichi Inada
Publikationsdatum: 01.04.2011
Verlag: Springer Japan
Erschienen in: Journal of Anesthesia / Ausgabe 2/2011
Print ISSN: 0913-8668
Elektronische ISSN: 1438-8359
DOI: https://doi.org/10.1007/s00540-011-1100-0

Neu im Fachgebiet AINS

23.04.2024 | Appendizitis | Nachrichten

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

hier abonnieren

Springer Medizin

The effect of one-lung ventilation upon pulmonary inflammatory responses during lung resection

Abstract

Purpose

Methods

Results

Conclusions

Neu im Fachgebiet AINS

Hinter dieser Appendizitis steckte ein Erreger

Ärztliche Empathie hilft gegen Rückenschmerzen

Mehr Schaden als Nutzen durch präoperatives Aussetzen von GLP-1-Agonisten?

S3-Leitlinie zu Pankreaskrebs aktualisiert

Update AINS

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 2/2011

Editorial note to the article by Onizuka et al.: Lidocaine depolarizes the mitochondrial membrane potential by intracellular alkalization in rat dorsal root ganglion neurons

Blockade of 5-HT2A and/or 5-HT2C receptors modulates sevoflurane-induced immobility

Severe stridor and marked respiratory difficulty after right-sided supraclavicular brachial plexus block

One-lung ventilation in a patient with stenting for tracheobronchial stenosis caused by esophageal cancer

Co-administration of ephedrine prevents reductions in cardiac output and systemic oxygen delivery secondary to lung compression maneuvers during one-lung ventilation, without reducing arterial oxygenation

Scientific publications in anesthesiology journals from East Asia: a 10-year survey of the literature

Neu im Fachgebiet AINS

Hinter dieser Appendizitis steckte ein Erreger

Ärztliche Empathie hilft gegen Rückenschmerzen

Mehr Schaden als Nutzen durch präoperatives Aussetzen von GLP-1-Agonisten?

S3-Leitlinie zu Pankreaskrebs aktualisiert

Update AINS